Genotype-Guided Use of P2Y12 Inhibitors: A Review of Current State of the Art.
Genotype-Guided Use of P2Y12 Inhibitors: A Review of Current State of the Art.
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DOI：
10.3389/fcvm.2022.850028
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发表时间：
2022
影响因子：
3.6
通讯作者：
Gumina RJ
中科院分区：
文献类型：
--
作者：
Al-Abcha A;Radwan Y;Blais D;Mazzaferri EL Jr;Boudoulas KD;Essa EM;Gumina RJ
嘌呤能受体Y型，亚型12（P2Y12）抑制剂的药效学已经发展。我们对P2Y12抑制剂代谢的理解揭示了影响药物代谢和抗血小板疗效的多态性，从而导致基因检测指导治疗。此外，血小板功能和生物化学的测定为我们理解“抗血小板”治疗的疗效提供了见解，确定了P2Y12治疗时血小板反应性高或低的患者。尽管有这些数据，但这些测试模式的实施尚未在医院系统中获得主流采用。鉴于三种临床可用的P2Y12抑制剂之间的效力差异，必须仔细考虑血栓形成和出血并发症之间的平衡，特别是对于大部分出血风险较高的患者。在这里，我们回顾了遗传和功能测试，风险评估策略，并为P2Y12抑制剂指导治疗的指南目前的数据。
The pharmacodynamics of the purinergic receptor type Y, subtype 12 (P2Y12) inhibitors has evolved. Our understanding of the metabolism of P2Y12 inhibitors has revealed polymorphisms that impact drug metabolism and antiplatelet efficacy, leading to genetic testing guided therapy. In addition, assays of platelet function and biochemistry have provided insight into our understanding of the efficacy of “antiplatelet” therapy, identifying patients with high or low platelet reactivity on P2Y12 therapy. Despite the data, the implementation of these testing modalities has not gained mainstream adoption across hospital systems. Given differences in potency between the three clinically available P2Y12 inhibitors, the balance between thrombotic and bleeding complications must be carefully considered, especially for the large proportion of patients at higher risk for bleeding. Here we review the current data for genetic and functional testing, risk assessment strategies, and guidelines for P2Y12 inhibitors guided therapy.